WASHINGTON, DC—Obesity and psychological problems are taking a toll on children. How can health providers, federal agencies, schools, and other entities address these issues in young people?

Private and public sector officials discussed solutions to these issues at a forum held by Arizona State University. Former US Surgeon General Richard Carmona, who outlined the problem, said that a child who is overweight or obese will also likely have a higher incidence of depression. “You will not be the cool kid who gets invited to the prom,” he said. “You will not be on the sports teams, you are going to be ostracized often. So, we see mental health is intersected with this physical health problem.”

Carmona pointed out that obesity and mental health issues directly affect national security and that obesity is the “number one cause” for uniformed services personnel not being retained on active duty.

Addressing Mental Health and Physical Health

Panelists said that children who need mental health help often do not receive it. According to the Institute of Medicine (IoM), due to a critical shortage of child psychiatrists, only 20% to 25% of children with mental health and behavioral problems receive treatment.

Bernadette Mazurek Melnyk, PhD, RN, dean and distinguished foundation professor at Arizona State University College of Nursing and Health Innovation, said that a greater number of children likely do not get treatment and that this is often due to inadequate screening for mental health issues.

Nurse practitioners and primary doctors may not screen because they do not have anyone to refer children to who need further help, and they themselves are not trained to treat these children, she said. “I firmly believe we have to prepare a workforce that is fully prepared to deal with those physical and mental problems, and we have to integrate physical and mental healthcare in primary care where families feel comfortable to take their children to deal with common concerns.”

Peter Jensen, MD, co-chair in the division of child psychiatry and psychology at the Mayo Clinic, said that changes to primary care are needed to better address mental health and obesity. He said that currently primary care residents are not often trained to deal with depression, ADHD, or behavioral management strategies to mobilize families to deal with problems like obesity.

Kyu Rhee, MD, chief public health officer for Health Resources and Services Administration (HRSA), said that it is also important to think about expanding help outside of the traditional healthcare setting of hospitals, since primary care physicians are often challenged by the limited amount of time that they have with their patients.

Rhee pointed to HRSA’s School Based Health Centers program that is designed to increase children’s access to primary care in the school setting. The program received a funding boost through the Patient Protection and Affordable Care Act (PPACA), signed into law last March. Rhee also said that federal funding will allow community health centers around the country to double the number of patients they currently serve. In addition, these community health centers will now be required to track key indicators such as Body Mass Index.

Panelists also said that prevention of mental health and obesity through increasing physical activity levels of children should be a major strategy in addressing these issues.

Melnyk also said that the College of Nursing and Health Innovation at Arizona State University is conducting a cognitive–behavioral intervention to improve teens’ mental health, healthy lifestyle behaviors, and academic outcomes. The study was made possible through a $2.3 million grant from NIH.

The study is a randomized controlled trial to test the short- and long-term effectiveness of teaching teens cognitive-behavioral skills to improve healthy lifestyle behaviors and reduce depressive symptoms. The research sample consists of 800 adolescents between 14 and 16 years old enrolled in Phoenix high schools. “We are teaching teachers how to integrate this 15-session intervention program within the school health program,” she said. “We are studying the effect of that intervention on both physical and mental health outcomes, as well as academic performance.”